DONALD R WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020711

License Status

EXPIRED

Business

First Name

DONALD R

Last Name

WALLACE

Suffix

Business Name

DONALD R WALLACE MD

Original Issue Date

05/06/1987

Effective Date

05/06/1987

Expiration Date

07/01/1990

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006